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Background:
Gingival retraction methods are used in dentistry for impressions of subgingival crown margins, such as, mechanical, chemical, chemicomechanical, and surgical. These methods may injure the gingival sulcular epithelium. Hence, the present study is carried out to evaluate the effect of different retraction materials, such as, Expasyl, Mag...
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Background:
Since periodontal diseases are primarily inflammatory in nature, the ability to detect inflammatory lesions in gingival tissue is essential for the diagnosis and monitoring of changes in gingival status. Gingival bleeding has been used as a reliable and objective clinical parameter not only for the evaluation of inflammatory conditions...
Introduction: Short clinical crowns may be treated with crown lengthening techniques. Sometimes
teeth need to be restored after the surgery. In these cases it is important not to invade the biological
width to avoid the different reactions of the periodontium. The objective of this review is to examine
the dimensional changes that occur at the leve...
Citations
... 20 In relation to chemo-mechanical methods, that is the use of retraction cords and medications, the chemical substances used are classified into vasoconstrictors such as αand β-adrenergics, 21 astringents such as ferric sulfate, chloride, aluminum sulfate and potassium, 22 as well as wireless retraction methods, which include the use of biomaterials such as magic foam cord, retraction paste, retraction capsule, among others. 23 Depending on the case and the clinical scenario, a wide variety of gingival retraction techniques are required; however, scientific evidence suggests that the most commonly used displacement method is the chemomechanical technique. 24,25 Presumably, the dentist and prosthodontist are familiar with the workflow of the clinical steps for determining the degree of lateral gingival displacement. ...
... the data on the risk of bias in the selected studies according to the JBI and CONSORT tools. In general, randomized clinical trials had a low risk of bias,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] whereas longitudinal and in vitro clinical studies 42-49,52-54 had a moderate risk of bias. ...
Objective
To describe the existing knowledge on the efficacy of the different gingival retraction systems (GRSs) in gingival displacement, to know their effects on biological functions of human gingival fibroblasts (HGFs), and on the expression of inflammatory mediators (TNF-α and MCP-1) in gingival crevicular fluid (GCF), and saliva.
Methods
The protocol used for this systematic review was registered in INPLASY: 202410005. A digital search was performed in the databases PubMed/MEDLINE, Scopus, Science Direct, Web of Science, and Google Scholar of the literature published in the English language in the last 17 years (from December 10th, 2006, to May 15th, 2023), and included retrospective randomized clinical studies, prospective, and in vitro experimental studies. In addition, PRISMA criteria were followed. The methodological validity of the selected articles was assessed using Joanna Briggs Institute (JBI) critical appraisal tool, and the modified Consolidated Standards of Reporting Trials checklist (CONSORT).
Results
27 articles published between 2006 and 2023 were evaluated. Six hundred 32 subjects, aged between 18 and 65, participated in the clinical studies. 93.7% of the studies assessed periodontally healthy patients, and only 6.3% evaluated patients with mild gingivitis. Also, 882 teeth were samples, of which the majority were posterior teeth (54%). The most commonly used GRSs was aluminum chloride gingival retraction paste (74%). The GCF samples were taken in 67% of the studies, and ELISA was used in all studies (100%) to determine inflammatory mediators. The most frequently analyzed marker was TNF-α (67%).
Conclusion
The system Merocel Strips (Mystic, conn, USA) achieved the highest level of gingival displacement (1.66 ± 3.7 mm). In addition, the braided cords produced the lowest TNF-α levels (0.43 ± 0.08pg/mL). Astringent systems such as ferric sulfate had higher toxicity in HGFs.
... With no damage to the junctional epithelium at the base of the sulcus or to the sulcus walls, the risk of inflammation caused by chemicals delivered in the matrix is reduced significantly [2] . Phataleet al. showed a higher percentage of intact junctional epithelium histologically with Expasyl in comparison to the use of a retraction cord [10] . The force of retraction offered is limited due to the elevated viscosity of the injectable matrix, and, while this protects the implant sulcus from the trauma of over packing, it may not offer sufficient retraction for situations that are unique to implant dentistry [11] . ...
Introduction: The precise reproduction of the abutment (implant) provides clinician with crucial clinical information of the relative position and orientation of the implant to other implants, teeth and soft tissue that allow them to fabricate exact- fitting, bio-integrated restoration. For that it is necessary to expose, access & isolate the implant region, especially when cement retained implant prosthesis are in consideration, where conventional crown and bridge impression and optical impression technique is used. Material and Method: Patient who accepted to participate were chosen for the study. Coincidentally all 15 patients were female. They were explained the purpose and methodology, agreed for periodic follow up at the interval of one month after placement of healing abutment and 7 days after using the retraction cord. Conclusion: The conclusions that were drawn from this study are: Both materials showed clinically and statistically significant amount of vertical soft tissue displacement. Among the both soft tissue displacement agents, non-impregnated retraction cord showed the more vertical soft tissue displacement than Expasyl Paste. But, the amount of retraction offered by this paste is limited with extremely subgingival margins. But the advantages with Expasyl paste over the retraction cord were its ease of application, painless, quick, and without agony to the patient.
... Numerous authors have focused on various retraction techniques employed in dentistry and the subsequent extent of undesirable gingival recession, as documented in references [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. ...
... It is worth noting that this retraction technique resulted in extremely low trauma to the gingival tissues compared to the traditional retraction cords. Other researchers have also acknowledged and reported similar findings in their studies [12,20,22]. ...
... Additionally, our study demonstrated fast recovery within a week after the impressiontaking process [12,23]. This means that the subjects involved in the study showed significant improvement and restoration of their gingival tissues within just one week after undergoing the retraction procedure. ...
The aim of the current article is to analyze and compare post-retraction gingival height changes resulting from six different types of gingival-displacement methods, encompassing both conventional and surgical approaches. The study involved a comparative analysis of 263 teeth (consisting of 128 front teeth, 69 premolars, and 66 molars) from 23 patients. For the investigation, three classic retraction methods were utilized, namely the single-cord technique, retraction paste Expasyl, and retraction paste Astringent. Additionally, three surgical techniques were employed, which included ceramic bur rotary curettage, Er:YAG laser troughing, and diode laser troughing. A randomized split-mouth design was implemented, and a significance level of 0.05 was used for the study. The recovery of the free gingival margin height was assessed on gypsum models that were scanned using an intraoral scanner during the first and second week after the retraction procedure. The results revealed that all retraction methods, except for ceramic bur rotary curettage, led to clinically insignificant levels of gingival recession. The article provides insights into the effectiveness and safety of various gingival-displacement techniques, highlighting that most methods tested in the study resulted in minimal or negligible gingival recession post-retraction.
... Вступ Успіх і довговічність незнімних реставрацій значною мірою залежить від процесу отримання відбитка, особливо коли краї препарування розширюються за рахунок ясенного простору [4,10]. Щоб зафіксувати ці життєво важливі крайові ділянки у відбитку, потрібен достатній простір між зубом та ясенним краєм [5]. ...
The purpose – to analyze the results of the use of the laser gum correction in orthopedic dentistry – the dynamics of pain syndrome, the depth of the dentogingival groove. Materials and methods. The data of 100 patients – 46.0 % men and 54.0 % women aged 30 to 74 years, average age 57.3±15.1 years were included into the work. A visual analog scale (VAS) was used to assess the severity of the pain syndrome. The measurement of the depth of the gingival groove was carried out by means of a graduated periodontal probe with a distribution value of 0.5 mm. The clinical condition of the marginal periodontal tissues was determined using the gingival index. Results. It has been proved that with the use of laser correction pain syndrome occurs only in 2.0 % versus 16.0 % in the diathermic correction group. That is, the «odds» (OR - odds ratio) of the pain syndrome at laser correction decreased by 10.0 times (р = 0.023). A lower intensity of the pain syndrome was established in the laser correction compared to diathermic (p<0.05). It has been verified that higher indicators of the gingival index were observed in the laser correction group versus diathermic correction group (p<0.05) (after 1 month of observation). It has been proved that the minimum penetration into the gingival groove was detected when taking an impression after performing correction by a diathermic method (50.8±6.23 %) in comparison with the laser (64.7±4.2 %), p<0.05. Conclusions. The study reflects the effectiveness of laser correction with the use of the «Lika Surgeon» device in the immediate and long-term results of orthodontic treatment of patients. It has been determined that the severity of the pain syndrome in the early period is less when using the laser. The depth of furrow penetration during prospective observation was greater when using laser correction.
... Displacement of the gingival tissues (retraction) is necessary because the impression of a fixed type of structures requires an accurate and detailed impression of the preparation margins, which in most cases are below the marginal gingiva 1,2 . The methods used for retraction of the gums can be divided into 3 categories or be a combination of them: mechanical, chemo-mechanical and surgical 3,4,5 . ...
Abstract The article aims to present evaluate the tensile strength of different retraction cord. In the research, we used 50 experimental units of each type of retraction cord (Ultrapak # 00; the two items created for the study – a thread with a core of monofilament and a thread without a core). The tensile strength test was performed in an LMT 100 micro-tensile apparatus after all test pieces of cords were immersed for 20 minutes in a 10% solution of Al2Cl3. The data was processed using the specialized statistical product SPSS (version 21). A critical significance level of p<0.05 is used. The tensile strength test of retraction sutures immersed in a 10% solution of aluminum chloride shows a statistically significant difference in the comparison between the two treated cords and Ultrapak # 00 (p <0.001). Impregnation with 10% Al2Cl3 increases the tensile strength of the samples with a monofilament core and the cotton braid without a monofilament and decreases the tensile strength of the samples of Ultrapak cord.
... All included studies were in vivo and published in English. Different retraction methods were compared evaluating: bleeding after retraction (8-10, 12, 14), recessions (6,12,14), changes in clinical attachment level (7,13), tooth mobility (7,13), probing depth (7,13), plaque index (7,14), pain during retraction (6,13), inflammatory cytokine levels in gingival crevicular fluid (GCF) (13) and effect on the gingival sulcular epithelium (11). All studies were divided into two groups. ...
... The remaining specimens show an intact junctional epithelium. Authors claim that there is a significant association between retraction materials and the gingival sulcular epithelium (11). ...
Aim. To evaluate the effect on post-operative results of different types of retraction techniques on periodontium. Material and methods. The following electronic databases sources were searched: PubMed, the Cochrane library and Researchgate. The search was carried out according to PRISMA guidelines. Due to lack of appropriate articles earliest period was not restricted, but only in vivo studies were included, articles were collected using keywords: “gingiva”, “displace”, “periodontal health”. Studies that met the inclusion criteria were evaluated using Cochrane risk of bias tool. Only low and moderate risk articles were included into this systematic review. Results. After duplicates removal 55 articles left from which 9 were included into this systematic review. The data from studies were collected and evaluated in a systematic manner. Data tables were created for summarisation. Conclusion. Gingival retraction has negative, but reversible effect on periodontium, which could lead to gingival bleeding, inflammation and even recession. Conventional retraction using retraction cord has more negative effect on periodontium also it is more painful method, than retraction paste.
... Gingival retraction cord is the conventional mechanical technique for gingival deflection, and both impregnated and non-impregnated cords are employed 8 . However, retraction cords demonstrate multiple disadvantages, including, technique sensitivity, trauma to junctional epithelium, inflammation and gingival recession, patient discomfort and bleeding 9 . A study by Wadhwani and Ansong 10 , described positive association between peri-implant disease and remnants of retraction cord system 10 . ...
Objective:
Conventional use of retraction cord in soft tissue management is effective only when the non-resilient nature of material does not jeopardize gingival health. Therefore this study aims to clinically evaluate the gingival displacement, ease of application and bleeding from polytetrafluoroethylene (PTFE) retraction cord.
Patients and methods:
This study is a single-center, parallel-group, randomized controlled clinical trial (1:1). Sixty patients indicated for full coverage metal-ceramic restoration for first molars were enrolled and randomly allocated to experimental (PTFE Cord) and control (conventional plain retraction cord) groups. After crown preparation and isolation, a pre-displacement impression was made. Assigned gingival displacement material was applied for 5 minutes, followed by post-displacement impression. Casts were prepared and used for assessment of mean horizontal gingival displacement by measuring displacement using a stereomicroscope (20 x). Post-displacement gingival bleeding and ease of application were also assessed clinically. t-test and Chi-square tests were used for statistical assessment of gingival displacement, gingival bleeding and ease of application.
Results:
Gingival displacement, bleeding and ease of application were similar among study groups (p > 0.05). Mean gingival displacement in the experimental group was 197.1 µm, and 167.7 µm in the control group. Bleeding was observed in 30% and 20% of cases of experimental and control group, respectively. Ease of application was 'difficult' in 53.3% and 43.3% of cases of experimental and control group, respectively. Non-impregnated gingival retraction cord and PTFE cord displayed similar outcomes of gingival displacement, ease of placement and bleeding after cord removal.
Conclusions:
Post-displacement bleeding and discomfort for PTFE cord placement suggest that this technique needs improvement. Therefore further studies are warranted to improve and investigate the physical and biological response to PTFE retraction cord.
... The best hemostatic effect was shown by the magic foam gel retraction system The key factor to achieve an accurate impression is the retraction of gingival tissues and control of the bleeding. The application time of cord should not be less than five minutes to avoid tissue collapse or greater than ten minutes to avoid irreversible recession 11 . Hence in the present study, the impregnated stayput retraction cord were left in the sulcus for a period of ten minutes for optimum retraction. ...
The marginal integrity of a restoration depends on the ability of impression material to accurately record the finish lines, which in turn will assure marginal adaptation and restoration aesthetics. To reveal the subgingival finish lines of preparation and to create enough room for the impression material, the gingiva must retracted vertically and horizontally be laterally. The most common and widely used method of gingival retraction uses a cord system for gingival displacement. Due to the technique-dependence of gingival displacement with cord, products like expasyl paste and magic foam gel were developed. Thus the primary objective of this study was to determine the amount of gingival retraction achieved in width and depth using impregnated stayput retraction cord compared to magic foam gel and expasyl paste measured in micrometers using stereomicroscope under 10X resolution of the cast obtained before and after retraction which was sliced buccolingually to obtain a three millimetre specimen. Secondary objective was to assess presence or absence of gingival bleeding in the sulcus after retracting all three agents and to determine time taken for placement. Null hypothesis was there is no significant difference in the width and depth of gingival sulcus retracted in fixed prosthodontic treatment using impregnated stayput cord compared to magic foam gel and expasyl paste gingival displacement systems. Results revealed that the null hypothesis was ruled out. Expasyl paste caused the greatest horizontal retraction. The largest vertical retraction was obtained by the impregnated stayput cord. The best hemostatic effect was shown by the magic foam gel retraction system. Applying Expasyl paste to the sulcus required less time.
... These findings are in partial agreement with the study findings regarding the amount of gingival displacement offered by magic foam ® paste which are less than retraction cord. Magic foam ® paste as a cordless retraction technique could be better and more tissue friendly than retraction cords from a histopathological point of view as mentioned by Phatale et al. (2010) [23]. ...
... These findings are in partial agreement with the study findings regarding the amount of gingival displacement offered by magic foam ® paste which are less than retraction cord. Magic foam ® paste as a cordless retraction technique could be better and more tissue friendly than retraction cords from a histopathological point of view as mentioned by Phatale et al. (2010) [23]. ...
Objective: to assess the amount of vertical and lateral gingival tissue displacement and recovery obtained by aretraction cord and Magic Foam® paste. Material and Methods: twenty- two participants, requiring full coverageprosthesis in the anterior area, were prepared using a deep subgingival chamfer finish line, then randomly allocatedto the retraction cord group (Group RC, n = 11 teeth) or the Magic Foam® Paste group (Group FP, n = 11 teeth).The amount of lateral and vertical tissue displacement was measured by comparing the pre- and post- displacementcasts at three fixed points (midbuccal, mesial and distal) using a stereomicroscope. After two weeks, tissue recoverywas assessed by taking an impression using a double mix. The amount of tissue recovery was measured verticallyfrom the gingival margin to the bottom of the sulcus and by comparing the results to the pre-displacement records.Results: there was no significant difference in the vertical gingival displacement (P > 0.05). However, there wassignificantly less lateral gingival displacement of the Magic Foam® Paste in the mesial and mid-buccal surfaces only(P < 0.05). The Magic Foam® Paste showed significantly more tissue recovery than the retraction cord (P< 0.05).Conclusion: both the retraction cord and the Magic Foam® Paste are considered effective means of retraction asthey give the least amount of retraction needed both laterally and vertically. KEYWORDSGingival retraction techniques; Gingiva; Retraction cord; Tissue recovery; Stereomicroscope.
... For patient satisfaction there is a clear difference between the cord and laser with the laser group more satisfactory to the patient due to elimination of the retraction force by the operator, a numeric scale from (0-5) was used according to Comley & DeMeyer (2001) instead of 0-10 points and that was with the recommendations of a physician consultant from the Pain Management Center. [17] Retraction cord produces the correct retraction, according to Phatale et al. (2010), although packing the cord is difficult. Physical pressure on the tissue is required, resulting in gingival bleeding. ...
... As a result, using the cord approach carries the danger of epithelial attachment injury, pain during cord packing, which normally necessitates local anaesthetic, and is also time consuming. [32] This study also confirmed by Sorrentino R et al. (2021) study, which said that the laser gingiva displacement seems to be relatively painless and improving patient comfort. [13] ...
This study was carried out to compare between two techniques of gingival retraction (retraction cord and diode laser) regarding the amount of tissue displacement both laterally and vertically. Also, Patient satisfaction during their application. Methodology: twenty two cases requiring full coverage porcelain fused to metal fixed prosthesis in the anterior esthetic zone were taken from the outpatient clinic of the fixed prosthodontics department – Cairo University. The teeth were prepared with subgingival deep chamfer finish line and were distributed according to the technique of gingival retraction. Group I: Patients receiving retraction with the retraction cord. Group II: Patients receiving retraction with diode laser. In both groups measurement of lateral and vertical displacement done by using the stereomicroscope. also, patient satisfaction was measured by Comley and Demeyer numeric pain scale. There was significant difference between the two groups regarding lateral and vertical displacement. Laser troughing give not only more amount of vertical but also more lateral retraction whereas, P<0.05. For the patient satisfaction there was a significant difference between both groups, with laser troughing give better results.
